Developmental Coordination Disorder (DCD)
What is DCD?
Developmental Coordination Disorder (DCD) is as a neurodevelopmental disorder with an early onset. It presents with motor performance deficits, difficulty in performing activities of daily living (ADLs) and participation restrictions in social settings which are not better explained by any intellectual disability, visual impairment or any neuromotor conditions such as CP, muscular dystrophy or degenerative disorders. DCD is a condition which is typically diagnosed at 5 years, when formal testing is possible but symptoms often show up earlier. Statistics show that approximately 5-6% of school going children present with clinical characteristics of DCD.
Growing evidence indicates that children with DCD are known to have different brain activity and dysfunction of cortical networks in comparison to peers. The areas of the brain associated with timing, motor control, motor learning, and spatial processing show reduced activation in children diagnosed with DCD. Therefore children with DCD often present with difficulty in gross motor skills requiring coordination, balance, timing and sequencing.
Children who are diagnosed with DCD often present with hypotonicity (low tone), joint laxity, and balance deficits such as standing on tip toes or standing on one foot. Poor participation in sports and outdoor play due to low confidence in performing movement skills often leads to obesity.
Developmental Coordination Disorder may be seen in children diagnosed with Autism Spectrum Disorder (ASD), Attention Deficit Hyperactive Disorder (ADHD attention deficit disorder (ADD) and with some Intellectual Disabilities when the motor disabilities are greater than intellectual disabilities. In a child with one of these diagnosis’, members of the interdisciplinary team can often screen for altered movement patterns and coordination in gross motor skills.
If your child is showing the following characteristics, you may want to have them evaluated for DCD:
- Increased clumsiness, dropping or bumping into objects/ people
- Slowness or inaccuracy while catching an object, using scissors or cutlery, or participating in sports
- Slower running speeds
- Difficulty galloping (after age 4) and skipping (after age 5)
- Difficulty in performing jumping jacks or jumping a rope (after age 5)
An Interdisciplinary Approach: Who should be on your child’s care team?
Your child’s primary care physician, a pediatric physical therapy, pediatric occupational therapist and a child psychologist should be on your child’s care team. If a child is already receiving PT, the therapist can screen for any red flags or provide a deeper analysis before referral to the PCP to provide an in-depth analysis of the child’s gross motor skill patterns. The OT is an integral part of the DCD team. It is essential that the team is in close communication with one another, and you as the parent or guardian, to ensure smooth carryover and generalization of skills.
Physical Therapy interventions for DCD
The two main approaches used in children diagnosed with DCD include Motor Skill Training and Neuromotor Task Training. Both of these approaches are task-oriented interventions. The goal is to start at present level of function and increase in complexity. The level of cueing also changes, starting with visual demonstration to progressing towards verbal cues and eventually towards what we PT’s like to call, ‘knowledge of performance’, also known as self-correction. Knowledge of performance is a cueing technique which utilizes one’s own body cues to perform an activity in the most effective and efficient manner.
Repetition is the key to achieving gross motor skills. In addition, generalizing a skill is just as important and therapist using these approaches start with a closed environment such as playing catch in sitting or standing and progressing to playing with different types of balls on different types of surfaces and eventually ask parents to play at home or at the park. Therapists can even collaborate with school teachers to ensure the skill is achieved in all environments.
Support your child at home
Children diagnosed or exhibiting symptoms of DCD require lots of verbal and visual cues to perform activities. Establishing targets to knock down or reach to is a great way to start learning a new skill. If you are practicing with skipping or galloping start out with use colored paper taped to the floor and associate a color with a leg, “righty red, lefty blue.” Practice activities in a variety of settings: at home, at a friends house, on a playground, wherever you can!
If you feel like your child is having a hard time coordinating his body, or is presenting with some of the symptoms mentioned in this post, feel free to reach out to Dynamic Solutions Pediatric Therapy to find out more information and get help determining if it may be time to get an evaluation.
Written by Reetu Patel, PT